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Most clinical research treats patients like data points. What gets lost when researchers stop listening to the people they study, and what does it cost the science itself? Niharika Singh is a biomedical engineer and pre-medical student with research experience at Genentech, …
Patient involvement and the future of clinical research [PODCAST]
Adult ADHD is real. It is impairing. It is often missed, especially in bright, high-achieving adults, women, and people who learned to compensate for years before finally burning out. But the solution to underdiagnosis cannot be overdiagnosis.
We are now seeing a second problem emerge: rushed adult ADHD evaluations, often completed in 30 to 60 minutes, sometimes based heavily on a brief questionnaire, followed quickly by stimulant prescribing. The patient may …
Rushed adult ADHD evaluations put patients at risk
Behavioral health is a core component of first-line, non-opioid treatment for chronic pain in most major medical guidelines, including the Centers for Disease Control and Prevention, the American College of Physicians, the World Health Organization, the American Academy of Neurology, the American Headache Society, and the American College of Gastroenterology. And yet, the concept of behavioral health to treat chronic pain still surprises many people, including …
Central sensitization is the key to treating chronic pain
I remember the moment clearly. A hot July day, standing at my mailbox, opening an envelope from a genetic testing company. I expected reassurance. Instead, I saw a result sitting in the bright red end of the risk continuum. As far from “OK” as it could get.
Years earlier, my son had mentioned that his 23andMe test showed he carried a gene that might lead to Alzheimer’s “when he was old.” …
Why the case against APOE4 testing no longer holds
We tell burned-out physicians to practice self-care, set boundaries, build resilience. And still, women are leaving medicine earlier and at higher rates than men, taking with them decades of clinical expertise and leaving behind a replacement cost that runs into the hundreds of thousands of dollars per physician. We’ve named burnout as the problem, but haven’t addressed an important driving factor. The missing piece isn’t a wellness app or a …
Physician loneliness is driving women out of medicine
When Bill Ritter, a longtime anchor for WABC-TV New York’s ABC7 Eyewitness News, recently announced that he had been diagnosed with early-stage Alzheimer’s disease, he shared that he is receiving treatments that are keeping the disease’s progression at bay. Unfortunately, many patients never receive the same opportunity for treatment because they are diagnosed too late.
With Alzheimer’s disease, delayed diagnosis can determine whether patients qualify for new treatments, clinical trials, and …
Early Alzheimer’s diagnosis now decides who gets treated
Every week, a familiar reflection settles into the corners of my mind as I look at my office desk. As a practicing psychiatrist, my days are spent navigating a gentle but persistent paradox. On one hand, my workspace is increasingly filled with paperwork: diagnostic standardizations, complex neuropsychological testing matrices, and formal institutional accommodation forms designed to categorize human behavior into neat, permanent columns. On the other hand, sitting across from …
Rethinking neuroplasticity and mental health in psychiatry
The first law: Nothing is lost
“I used to be smart, now I can’t think. I used to solve puzzles pretty easily, but now I don’t have any logic whatsoever. Sometimes I don’t even remember the days I had a week ago. I don’t know why my brain doesn’t work anymore.”
I kept seeing the same grief in different words: people who were not simply sad, but bewildered by the disappearance of …
The thermodynamics of depression brain fog
There’s a table somewhere. A conference room, good lighting, people who care. Someone passes a document around. Someone else has a slide deck. They’re talking about health care, about access, about cost, about what patients need and what physicians should do in fifteen minutes.
Fifteen minutes.
Has anyone at that table ever had their pain evaluated in fifteen minutes? Their chronic disease managed? Their whole complicated life, the medications, the specialists, the …
Primary care is the conductor medicine forgot
Maria was 42 years old when she died alone.
As an internal medicine resident and future addiction medicine physician, I have the immense honor of caring for undocumented immigrants at a nonprofit community clinic in Philadelphia. As the granddaughter of Cuban political refugees, caring for immigrant populations is central to my identity as a physician. As such, I am proud to work at a clinic that provides care to patients who …
Deportation and addiction: My patient died alone
René Laennec invented the stethoscope in 1816 because he was uncomfortable placing his ear directly on a young woman’s chest. Werner Forssmann performed the first cardiac catheterization, on himself, in 1929, threading a catheter through his own arm into his heart because no ethics board would have approved it on a patient. Graeme Clark developed the cochlear implant after watching his deaf father struggle to communicate. Charles Kelman revolutionized cataract …
Why physician-led innovation in health care stalled
Twenty-five years ago, 15-year-old Lewis Blackman died following elective surgery at a respected South Carolina hospital. Since he was placed in a suboptimal ward that was inadequate for his condition, his health worsened from a perforated ulcer and overwhelming infection, warning signs were missed, family concerns were not adequately escalated, and life-saving treatment came too late. His death became one of the most influential patient safety cases in American …
Hospital overcrowding makes safe care impossible
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A 30 to 40 percent Medicare cut just hit the doctors who keep your local hospital running, and the policy meant to stop hospital monopolies is accelerating them instead. John Birkmeyer, president of the medical group at Sound Physicians and a former …
How Medicare’s new cut is closing private doctor practices [PODCAST]
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For years, we have told women to get their mammograms. We have wrapped buildings in pink lights. We have filled October with ribbons, walks, campaigns, commercials, survivor stories, and reminders. We have created an entire cultural season around breast cancer awareness. And still, millions of women do not get screened on time.
At some point, we have to ask a more uncomfortable question: What if awareness was never the real problem?
As …
Why women miss mammograms has nothing to do with awareness
Not long ago, a woman came into my office with breast implants that were forty-one years old. The implants were older than I am.
As a plastic surgeon who specializes in breast and body procedures, that is the longest I have personally seen implants last. And honestly, my first reaction was probably the same reaction most people would have: disbelief. Forty-one years is an incredibly long time for any medical device …
How to rethink old breast implants as your body ages
Life’s most meaningful memories are often built around shared experiences. Whether it’s a wedding toast, a graduation ceremony, a holiday dinner, or a grandchild’s soccer game, these are the moments families remember for years, not because of where they happened, but because of the conversations, laughter, and connections that took place along the way. Unfortunately, hearing loss can create invisible barriers that prevent people from fully experiencing those moments.
As an …
When hearing loss in older adults steals connection
Imagine a cancer therapy that literally poked holes in cancer cells, destroying them. Imagine that this therapy was approved by the federal Food and Drug Administration and was available to patients and their oncologists, and that it could cure your cancer. We imagine you would expect patients to clamor for this treatment, but this is where the imagination falls short, because this therapy exists and is approved, but it is …
CAR-T therapy can cure cancer. Why is it so underused?
You have witnessed it, probably this week. A stranger correcting another stranger’s behavior. A comment on someone’s parenting, posted for an audience of thousands. A heated exchange over a parking spot that somehow becomes a referendum on someone’s character. The neighbor who reports another neighbor’s hedge height to the township. The pile-on that turns a stranger’s bad day into a national referendum, complete with their employer tagged in the replies.
Correcting …
What public shaming reveals about a loss of trust
I never expected to spend my retirement navigating a health care system that increasingly requires patients to do the work once handled by the system itself. But that is where we are. The modern patient must track their own records, coordinate their own referrals, chase their own authorizations, and solve problems that once belonged to the infrastructure. It is a strange inversion: the more complex the system becomes, the more …
Why is patient care coordination now a DIY project?
Health care keeps asking how to recruit more clinicians.
That question matters. But it is not the only one. We should also be asking why fewer clinicians are staying.
Across the country, health care leaders are sounding alarms about workforce shortages, access challenges, burnout, and turnover. The proposed solutions are familiar: increase reimbursement, recruit more clinicians, expand training programs, and improve efficiency.
All of those efforts matter. But much of the conversation still …
Why clinicians leave and why they used to stay
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